Ultra-processed foods and recommended intake levels of nutrients linked to non-communicable diseases in Australia: evidence from a nationally representative cross-sectional study

Machado, Priscila Pereira; Steele, Eurídice Martinez; Levy, Renata Bertazzi; Sui, Zhixian; Rangan, Anna; Woods, Julie; Gill, Tim; Scrinis, Gyorgy

doi:10.1136/bmjopen-2019-029544

Cited by 192 publications

(227 citation statements)

References 51 publications

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“…Fifteen percentage of animal energy content may appear small at first view, but it is sufficient to supply all the essential macro-and micronutrients, provided the third rule (varied) is correctly applied (Tables 5 and 6). In addition, a reduction in ultra-processed energy content ('empty' energy content) will bring in new, minimally processed nutrient-dense foods rich in bioactive compounds that are protective against chronic diseases (i.e., more fibre, vitamins, minerals and antioxidants) (46)(47)(48)(49)(50)(51)96,97) . Notably, iodine and vitamin A DRI are easier to address when including a weekly serving of seaweeds/seafood (e.g., dried seaweeds) and offal/giblets (e.g., animal liver), respectively.…”

Section: Discussionmentioning

confidence: 99%

How to protect both health and food system sustainability? A holistic ‘global health’-based approach via the 3V rule proposal

Fardet

Rock

2020

Public Health Nutr.

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Objective: To define a generic diet to protect human health and food system sustainability based on three dimensions: animal:plant ratio, degree of food processing and food diversity. Design/setting: The percentages of maximum animal and ultra-processed energy content were evaluated from scientific papers (Web of Science database) and reports from international scientific institutions. Then, a weekly French standard diet, including these percentages and food diversity (≥42 different foods), was designed to calculate adequacy to nutritional needs. Results: Based on traditional and scientifically based healthy diets, and on foresight scenarios for sustainable diets at horizon 2050, a median daily animal energy content intake of 15 % was found to be protective towards both human health and environment. Based on epidemiological studies associating ultra-processed energy consumption with increased overweight/obesity risk, a precautionary threshold of approximately 15 % ultra-processed energy content was observed. The French diet allows addressing all nutritional needs and other nutritional indicators such as maximum salt and simple sugar consumption, α-linolenic acid:linoleic acid ratio and essential amino acids. This diet was named the ‘3V rule’ for Végétal (plant), Vrai (real) and Varié (varied, if possible organic, local and seasonal). This generic diet can be adapted according to regional traditions and environmental characteristics. Excluding only one dimension of it would threaten both health and food system sustainability. Conclusions: Tending towards a 3V-based diet, while respecting local constraints, should allow preserving human health, environment (greenhouse gas emissions, pollution, deforestation, etc.), small farmers, animal welfare and biodiversity, culinary traditions and socioeconomics (including an alleviation of public health cost).

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Section: Discussionmentioning

confidence: 99%

How to protect both health and food system sustainability? A holistic ‘global health’-based approach via the 3V rule proposal

Fardet

Rock

2020

Public Health Nutr.

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“…These studies showed a trend in the last decades toward a decrease in the consumption of fresh food (mainly vegetables and fruits) in favor of ultra-processed foods ( 247 ) and how this change correlates with the increase in obesity prevalence worldwide. Other studies have correlated the consumption of ultra-processed foods with the increase in sugars, saturated and trans-fat, and Na intake, that in addition, correlate with an associated higher energy intake and obesity prevalence ( 248 – 251 ). In relation to the increase in cancer incidence associated with MetS, Fiolet et al found that a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase (>10%) in the risk of overall cancer and more specifically of postmenopausal breast cancer, the most commonly related to obesity ( 237 ).…”

Section: Metabolic Syndrome: Definitionmentioning

confidence: 99%

Mechanisms Underlying Biological Effects of Cruciferous Glucosinolate-Derived Isothiocyanates/Indoles: A Focus on Metabolic Syndrome

Esteve

2020

Front. Nutr.

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An inverse correlation between vegetable consumption and the incidence of cancer has long been described. This protective effect is stronger when cruciferous vegetables are specifically consumed. The beneficial properties of vegetables are attributed to their bioactive components like fiber, antioxidants vitamins, antioxidants, minerals, and phenolic compounds. Cruciferous vegetables contain all these molecules; however, what makes them different are their sulfurous components, called glucosinolates, responsible for their special smell and taste. Glucosinolates are inactive biologically in the organism but are hydrolyzed by the enzyme myrosinase released as a result of chewing, leading to the formation of active derivatives such as isothiocyanates and indoles. A considerable number of in vitro and in vivo studies have reported that isothiocyanates and indoles elicit chemopreventive potency through multiple mechanisms that include modulation of phases I and II detoxification pathway enzymes, regulation of cell cycle arrest, and control of cell growth, induction of apoptosis, antioxidant activity, anti-angiogenic effects, and epigenetic regulation. Nuclear erythroid 2-related factor 2 (Nrf2) and Nuclear factor-κB (NF-κB) are key and central regulators in all these processes with a main role in oxidative stress and inflammation control. It has been described that isothiocyanates and indoles regulate their activity directly and indirectly. Today, the metabolic syndrome (central obesity, insulin resistance, hyperlipidemia, and hypertension) is responsible for a majority of deaths worldwide. All components of metabolic syndrome are characterized by chronic inflammation with deregulation of the PI3K/AKT/mTOR, MAPK/EKR/JNK, Nrf2, and NF-κB signaling pathways. The effects of GLSs derivatives controlling these pathways have been widely described in relation to cancer. Changes in food consumption patterns observed in the last decades to higher consumption of ultra-processed foods, with elevation in simple sugar and saturated fat contents and lower consumption of vegetables and fruits have been directly correlated with metabolic syndrome prevalence. In this review, it is summarized the knowledge regarding the mechanisms by which cruciferous glucosinolate derivatives (isothiocyanates and indoles) directly and indirectly regulate these pathways. However, the review places a special focus on the knowledge of the effects of glucosinolates derivatives in metabolic syndrome, since this has not been reviewed before.

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“…First, unfavorable nutritional composition of ultra-processed foods may be a key factor driving the observed associations. It has been found that ultra-processed food consumption is positively associated with added sugar intake and inversely associated with dietary ber intake [36], both of which are shown to be predictive of cardiovascular mortality [37,38]. Second, chemicals may transfer from packaging materials to food contents, some of which may have detrimental impacts on cardiometabolic health [39].…”

Section: Interpretation and Comparison With Other Studiesmentioning

confidence: 99%

Association of Ultra-processed Food Consumption With Cardiovascular Mortality in the US Population: Long-term Results From a Large Prospective Multicenter Study

Zhong

Yang

Wang

et al. 2020

Preprint

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Background Ultra-processed foods have now become dominant in the global food system. Whether their consumption is associated with cardiovascular mortality remains controversial. Moreover, data on ultra-processed foods and cardiovascular outcomes are scarce in the US population. We aimed to examine the association of ultra-processed food consumption with cardiovascular mortality in a US population. Methods A population-based cohort of 91891 participants was identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Dietary data were collected through a validated 137-item food frequency questionnaire. Ultra-processed foods were defined by the NOVA classification. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular mortality. Restricted cubic spline regression was used to test nonlinearity. Subgroup analyses were conducted to identify the potential effect modifiers. Results After an average follow-up of 13.5 years (1236049.2 person-years), 5490 cardiovascular deaths were documented, including 3985 heart disease deaths and 1126 cerebrovascular deaths. In the fully adjusted model, participants in the highest vs. the lowest quintiles of ultra-processed food consumption had higher risks of death from cardiovascular disease (HRquintile 5 vs. 1, 1.52; 95% CI, 1.39–1.67) and heart disease (HRquintile 5 vs. 1, 1.70; 95% CI, 1.52–1.89) but not cerebrovascular disease (HRquintile 5 vs. 1, 1.00; 95% CI, 0.80–1.23). A nonlinear dose–response pattern was observed for overall cardiovascular and heart disease mortality (all Pnonlinearity<0.05), with a threshold effect observed at ultra-processed food consumption of 2.5 servings/day and 2.4 servings/day, respectively; below the thresholds, no significant associations were observed for these two outcomes. Subgroup analyses showed that the increased risks of mortality from ultra-processed foods were significantly higher in women than in men (all Pinteraction<0.05). Conclusions High consumption of ultra-processed foods is associated with increased risks of overall cardiovascular and heart disease mortality. These harmful associations may be more pronounced in women. Our findings are needed to be confirmed in other populations and settings.

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Ultra-processed foods and recommended intake levels of nutrients linked to non-communicable diseases in Australia: evidence from a nationally representative cross-sectional study

Cited by 192 publications

References 51 publications

How to protect both health and food system sustainability? A holistic ‘global health’-based approach via the 3V rule proposal

How to protect both health and food system sustainability? A holistic ‘global health’-based approach via the 3V rule proposal

Mechanisms Underlying Biological Effects of Cruciferous Glucosinolate-Derived Isothiocyanates/Indoles: A Focus on Metabolic Syndrome

Association of Ultra-processed Food Consumption With Cardiovascular Mortality in the US Population: Long-term Results From a Large Prospective Multicenter Study

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